tbuckley/cabot-search huggingface dataset:
Abstract P603: Diet Quality Scores Measured With Standard and Modified Component Weights Are Associated With Mortality Risk in the Multiethnic Cohort
Authors: Haley W Parker, Ashley Buchanan, Brietta Oaks, Maya Vadiveloo
Journal: Circulation (2023)

Introduction: The Dietary Patterns Methods Project reported higher scores of four selected dietary indices were all inversely associated with mortality risk. Diet quality components are generally weighted equally but previous meta-analyses and NHANES analyses suggest some may be more integral for mortality risk reduction. Thus, we examined if modified weight (vs. standard) Healthy Eating Index (HEI)-2015 scores were differently associated with all-cause and cardiovascular (CVD) mortality risks. Hypothesis: High modified weight (vs. standard) HEI-2015 scores will be associated with stronger mortality risk reduction. Methods: Data from adults (n=156,863) enrolled in the Multiethnic Cohort (MEC) Study recruited between 1993-96 from Hawaii and California with vital status and dietary data were analyzed. Baseline diet quality was assessed with the HEI-2015 using a food frequency questionnaire. Standard component weights of 5 or 10 points on 9 adequacy and 4 moderation components were reweighted creating two modified HEI scores, the Key Facets HEI with equally weighted fruits, vegetables, whole grains, and plant proteins and the Machine Learning (ML)-weighted HEI, calculated using weights reflecting relative component contributions to mortality risk from a prior analysis of NHANES III adults using LASSO models. All 3 HEI scores were assigned to deciles; sex-stratified, adjusted Cox models evaluated associations of HEI deciles with all-cause and CVD mortality risk. Results: Participants represented 5 ethnic groups (24% White, 16% African American, 23% Latino, 29% Japanese American, and 7% Native Hawaiian), and 55.3% were women. The mean age was 59.1 years, mean BMI was 26.4 kg/m 2 , and 27.3% were college graduates. For men and women, high scores (≥90th, vs. &lt;10th percentile) on all HEIs were significantly associated (p&lt;0.05) with 10% to 24% reduced all-cause and CVD mortality risks. Conclusions: Similar mortality risk reductions were observed for standard and modified weight diet quality scores in this sample.
Abstract P530: Building a Heart Disease Detection Web Application
Authors: Joana Tome, Logan Cowan
Journal: Circulation (2023)

Introduction: Heart disease continues to be a leading cause of death worldwide; hence early detection of the disease is recommended to reduce the fatality rate. Consequently, prediction models with high accuracy scores become important. Previous research has demonstrated encouraging results; however, concerning issues such as variations in databases and small-seized databases are still present. Hypothesis: We assessed the hypothesis that the web application which includes user input, a large database, and a machine learning model, will be able to predict the occurrence of heart disease with a high accuracy score. Methods: A web application composed of two modules, the admin and the user side, was built. The admin side consisted of a prediction model that was built based on a database and a classification algorithm. When creating the admin side, this project used data from the third visit of the multi-center population-based cohort study, the Atherosclerosis Risk in Communities (ARIC) study. There were a total of 11,351 participants on the third ARIC visit. Heart disease and other variables such as age, gender, race, education, smoking, drinking, physical activity, etc., were selected to build the prediction model of the web application. The database was split into independent ‘x’s and dependent ‘y’, and was furthermore randomly split into 75% (8,514 of 11,351) training and 25% (2,837 of 11,351) testing data. A model was created through the random forest classifier based on the trained and tested data. The user side consisted of provided fields or features that allow the user to insert his input into the web application. The user input is compared with the data used to build the web application’s prediction model. After the user inputs his information, the prediction model predicts the disease and gives the model test accuracy scores. The web application was built in Python with the help of the main packages and libraries such as streamlit, pandas, numpy, sklearn, and PIL. Results: The machine learning model achieved high accuracy in predicting heart disease. Conclusions: In conclusion, the current findings suggest that high disease prediction model test accuracy scores can be achieved when using random forest. Machine learning can be an effective tool in the early detection of heart disease and in making decisions for further prevention and treatment improvement.
Abstract P366: Enrollment in Medicare Managed Care Plan is Associated With Higher Adherence to Anti-Hypertensive Drugs
Authors: Donglan Zhang, Jianing Xu, Daniel Hall, Xianyan Chen, Jasmin Divers, Jingkai Wei, Janani Rajbhandari-Thapa, Henry Young
Journal: Circulation (2023)

Introduction: Adherence to anti-hypertensive drugs, which is sub-optimal despite public health and policy efforts, is essential in controlling high blood pressure. Medicare Advantage plans are gaining popularity, partly due to their managed care designs that held promise to improve chronic disease management. Hypothesis: We assessed the hypothesis that hypertensive patients with a managed care plan have higher adherence to antihypertensive drugs than those with a non-managed care plan. Methods: We analyzed medication adherence – measured using proportion of days covered (PDC) over 12 months for antihypertensive drugs – among 174,172 patients with a hypertension diagnosis from the medical and pharmacy claims and benefits data in the 2017-2019 IBM MarketScan Research Database. We fitted separate generalized linear regression models among monotherapy (use of one class of antihypertensive drugs) and polytherapy (combined use of at least two classes of antihypertensive drugs) users and computed postestimation margins with the best-fitted model to compare medication adherence by plan type: 1) Managed Care exclusive provider organization and health management organization (EPO/HMO) plan, 2) Managed Care point-of-service plan, 3) Managed Care preferred provider organization plan, 4) non-Managed Care comprehensive plan, 5) non-Managed Care consumer driven health plan / high deductible health plan. Other patient characteristics included in the analyses were age, age-squared, sex, comorbidities, census region, and their interaction terms. Results: The average PDC among Medicare patients on monotherapy was 0.53 and among those on polytherapy was 0.74. Patients with a managed-care EPO/HMO plan had the highest PDC (0.53, 95% confidence interval [CI]: 0.52, 0.54 among monotherapy users and 0.73, 95% CI: 0.72, 0.74 among polytherapy users, respectively) and those with a non-managed care comprehensive plan had the lowest PDC (0.42, 95% CI: 0.41, 0.43 among monotherapy users and 0.62, 95% CI: 0.61, 0.63 among polytherapy users, respectively). By census region, patients living in the North Central region with a managed care EPO/HMO plan had the highest average PDC (0.71, 95% CI: 0.70, 0.72 among monotherapy users and 0.85, 95% CI: 0.84, 0.86 among polytherapy users, respectively). Other factors such as age, sex, and number of chronic conditions were significantly associated with PDC. Conclusions: In conclusion, with an increase in the proportion of older adults enrolled in Medicare Advantage insurance, managed care models may play a more important role in influencing adherence to essential drugs such as anti-hypertensive drugs among Medicare beneficiaries. Future research should investigate factors that promote adherence to medications across different managed care plan designs.
Abstract MP25: Circulating Odd-Chain Fatty Acids and Mortality Risk After Myocardial Infarction in the Alpha Omega Cohort
Authors: Esther Cruijsen, Kamalita Pertiwi, Johanna M Geleijnse
Journal: Circulation (2023)

Background: Circulating odd-chain fatty acids (OCFAs) 15:0 and 17:0, potential biomarkers of dairy (fat) intake, have been associated with cardiometabolic outcomes in population-based studies. Whether circulating OCFAs are related to mortality risk in patients who experienced a myocardial infarction (MI) is not yet clear. Methods: We included 4,741 Dutch patients aged 60-80 y (78% males) from the Alpha Omega Cohort, who experienced a myocardial infarction (MI) up to 10 years prior to study enrolment. At baseline (2002-2006), data were obtained on risk factors for cardiovascular disease (CVD), medication, lifestyle factors and dietary intakes (203-item FFQ). Fatty acids in serum cholesteryl esters (CE) were assessed using gas chromatography. Multivariable Cox models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CI) for total and CVD mortality in relation to 15:0 and 17:0 in CE (per 10 th to 90 th percentile range, P 10-90 ). HRs were adjusted for age, sex, education, BMI, physical activity, diabetes, other CVD risk factors, medication, circulating linoleic acid, circulating EPA+DHA, and dietary factors. Missing data imputation was performed for confounders. Findings: Most patients used cardiovascular drugs (statins: 85%) and 979 patients (21%) had diabetes. During a median follow-up period of 12.4 years (total of 52,625 person-years), 2,233 patients died, of whom 984 from CVD. Circulating levels (% of total fatty acids) were low for 15:0 (median: 0.16; P 10-90 : 0.11-0.21) and 17:0 (median: 0.08; P 10-90 : 0.00-0.11). For 15:0, age and sex adjusted HRs per P 10-90 were 0.88 (95% CI: 0.81-0.95; P =0.001) for total mortality and 0.94 (0.83-1.06) for CVD mortality. In the most adjusted model, HRs for 15:0 were 0.92 (0.84-1.00; P =0.042) and 0.97 (0.85-1.11), respectively. For 17:0, HRs were 0.94 (0.85-1.05) for total mortality and 0.97 (0.83-1.13) for CVD mortality. Stratified analyses by sex showed inverse associations for 15:0 mainly in men (total mortality: HR of 0.90 [0.82-1.00]; P =0.047). For 17:0, inverse but non-significant associations were mainly observed in women (total mortality: HR of 0.85 [0.68-1.05]). Associations for 17:0, but not for 15:0, were stronger in diabetic patients (total mortality: HR of 0.78 [0.64-0.96]; P =0.019). Conclusions: Higher circulating OCFA levels may be related to a lower mortality risk after MI, which needs confirmation in other cohorts of CVD patients. The role of dairy fat intake in this relationship warrants further investigation.
Abstract P135: Travel Time to Specialty Care and Risk of Death for Children With CHD
Authors: Devin Parker, Meagan Stabler, Callie Young, Meghan Zimmerman, Todd Mackenzie, Xun Shi, Jeremiah R Brown
Journal: Circulation (2023)

Introduction: Children with congenital heart disease (CHD) typically require care from a multi-disciplinary team of providers and treatment at specialized care centers. Although access to specialty care is known to influence patient outcomes, little is known regarding geographic access to care for children with congenital heart disease. This study calculated travel time to specialized care centers and the relationship with mortality for children residing in Colorado. Methods: We analyzed all payer claims data (APCD) from Colorado (CO) from 2012-2019. Travel times were calculated using a network analysis of the road distance weighted by travel speeds from the geographic centroid of every ZIP code in CO to that of the actual specialized care center. Specialty care centers were uniquely identified by their National Provider ID (NPI) and defined by categorizations from the American Medical Association (AMA). Mortality was defined by discharge status. Results: There were 27,344 children with CHD who received specialized care in the study period, accounting for 437,071 total encounters. Of the children with CHD, there were 355 deaths. Children that died had an average of 98 visits per year, while children that survived had an average of 70 visits (p=&lt;0.001). Among the children who lived, 62.8% of their total specialty care visits were &lt;30 minutes away, compared to 59.7% among those who died. CHD who died had a consistently higher proportion of visits that required greater travel to care. Conclusion: Specialized care centers are often located in urban areas and treat patients from diverse geographic areas. There is significant travel burden for children with CHD.
Abstract P380: Linkage, Empowerment, and Access to Prevent Hypertension: A Novel Program to Prevent Hypertension and Reduce Cardiovascular Health Disparities in Detroit Michigan
Authors: Ijeoma Opara, Robert D Brook, Michael J Twiner, Katee Dawood, Phillip D Levy
Journal: Circulation (2023)

Background: Serious health disparities persist across the United States (US) whereby Black communities suffer a disproportionate burden of cardiovascular diseases. A higher prevalence of hypertension along with lower control rates are major contributing factors; while mounting evidence supports that negative social determinants of health (SDoH) play a causal role. Here, we describe a first-of-a-kind approach to reduce health disparities by focusing on preventing hypertension in Black adults with elevated blood pressure (BP) living in socially vulnerable communities. Methods and Results: LEAP-HTN (Linkage, Empowerment, and Access to Prevent Hypertension) is part of the RESTORE (Addressing Social Determinants to Prevent Hypertension) Health Equity Research Network, a $20 Million initiative funded by the American Heart Association. The trial will test if a novel intervention reduces systolic blood pressure (BP) (primary outcome) and prevents the onset of hypertension over one year versus usual care in 500 Black adults with elevated BP (systolic BP 120-129 mm Hg; diastolic BP &lt;80 mm Hg) in Detroit, Michigan. LEAP-HTN improves access to health care by leveraging our groundbreaking platform using geospatial health and social vulnerability data to direct deployment of mobile health units (MHUs) to communities of greatest need. Preliminary data suggest that 10% of patients screened for HTN in the MHUs would meet BP inclusion criteria. All patients are referred to primary care providers. Trial participants in the active limb will receive additional collaborative care delivered remotely by community health workers using an innovative strategy termed PAL 2 (Pragmatic, Personalized, Adaptable Approaches to Lifestyle and Life Circumstance)(Figure). PAL 2 emphasizes the mitigation of negative SDoH, thereby reducing allostatic load while fostering greater success in achieving lifestyle changes. Conclusions: LEAP-HTN aims to lower BP and prevent hypertension by improving access and linkage to healthcare while mitigating negative SDoH. Through an innovative patient-centered intervention, PAL 2 , our program model may represent a sustainable and scalable strategy to help overcome persistent health disparities in socially vulnerable communities across the US.
Abstract P587: Patients With Diabetes Mellitus and Atrial Fibrillation Affected by Non-Alcoholic Fatty Liver Disease Have Greater Risk of Mortality and Worse Clinical Outcomes
Authors: Leonid Khokhlov, Amr Aboelnasr, Michael Fatuyi, Leanne Pereira, Mehnaaz Ali, Fatima Hussain, Amanda Brown, Kamal Shemisa
Journal: Circulation (2023)

Background: Patients with diabetes mellitus (DM) are increasingly affected by AF. Non-Alcoholic Fatty Liver Disease (NAFLD) is an emerging disease and risk factor of interest that predisposes to adverse outcomes. Nevertheless, there is limited scientific evidence of clinical outcomes of NAFLD in patients with AF&amp;DM. Therefore, we sought to investigate this population. Methods: We queried NIS between 2016-2019 for adult patients who were hospitalized with AF&amp;DM and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value &lt; 0.05 was significant. Results: There were 6,723,293 patients with AF&amp;DM and 253,639 (3.7%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 70.4 vs. 73.8 yrs; males 57.2% vs 55.6%; Caucasians 70.5% vs 73.9%; HTN 20.3% vs 29.2%; HF 61.4% vs 56%; CKD 53.4% vs 45.2%; obese 26.9% vs 27.1%; dyslipidemia 49.8% vs 61.9%; anemia 24.8% vs 19.2%; history of MI 10.9% vs 13.3%; stroke 2.4% vs 4.1%, COPD 28.8% vs 31.1%; alcohol use 5.2% vs 2.2%, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). Conclusion: AF&amp;DM patients with NAFLD demonstrated significantly worse clinical outcomes and higher resource utilization. They were younger, with greater comorbid HF, anemia, CKD. Cardiogenic shock, cardiac arrest and GI bleed were all higher in the NAFLD subgroup. NAFLD may therefore raise the risk for ventricular dysfunction and coagulopathy. Awareness of this risk factor is essential in the AF&amp;DM population. Further research is necessary to assess long-term outcomes.
Abstract P550: Genome-Wide Association Analysis Identified Genetic Variants Associated With Cardiac Structure and Function in the Hispanic Community Health Study/Study of Latinos
Authors: Guning Liu, Qibin Qi, Robert Kaplan, Susan Cheng, Carlos J Rodriguez, Bing Yu
Journal: Circulation (2023)

Introduction: The role of genetic variants on cardiac structure and function among the Hispanic/Latino population is unclear. Hypothesis: We hypothesize that common genetic variants are associated with cardiac structure and function measures in the Hispanic/Latino population. Methods: We performed genome-wide association analyses of nine echo measures among individuals from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), including: left ventricular end-systolic volume (LVESV), LV end-diastolic volume, mean wall thickness, LV mass index, LV ejection fraction (LVEF), stroke volume (SV), septal early mitral annular velocity, ratio of early ventricular filling peak velocity to early mitral annular velocity, and left atrial volume index. We further conducted enrichment analysis to locate candidate gene pathways and performed replication using data from UK BioBank (UKB) and BioBank of Japan (BBJ). Results: We included 4471 Hispanic/Latino participants from two sub-cohorts of HCHS/SOL (mean age 55 and 59, 68% female). Fourteen previously unreported variants at 3 loci were associated with LVEF, SV, or LVESV (p-value &lt; 5х10 -8 , Figure ). Twelve of the 14 variants were associated with LVEF, located on or nearby ncRNA gene LOC105374813 , as well as 1 SNP on gene IPO5 with SV and 1 SNP on gene PGBD5 with LVESV. There were 199 variants that reached suggestive significance (p&lt;5х10 -7 ) for nine measures, with most SNPs had effect directions consistent compared to UKB and BBJ findings. FUMA enrichment analysis showed SNP associated with SV on IPO5 had higher expression in kidney, liver, and heart tissue compared to other tissues. For variants associated with LVEF, eQTL analysis with heart tissue showed that gene RP11-342K6.2 and GCFC2 had chromatin interaction in the region. Conclusions: We identified 14 loci associated with cardiac structure and function among Hispanics/Latinos, providing supporting evidence of genetic contribution to cardiac dysfunction in Hispanic/Latino populations.
Abstract P653: Cardiac Rehabilitation Participation is Associated With Lower Risk of Major Adverse Cardiovascular Events Across Race or Ethnicity and Income
Authors: Joshua Garfein, Gretchen Swabe, Daniel E Forman, Jared W Magnani
Journal: Circulation (2023)

Introduction: Cardiac rehabilitation (CR) participation reduces the likelihood of major adverse cardiovascular events (MACE), but is limited by structural factors, including race or ethnicity and annual income. We investigated (1) associations between CR participation and MACE, and (2) how structural disadvantage modifies this association, focusing on the intersection between race or ethnicity and household income. Hypotheses: We hypothesized that (1) CR participation would be inversely associated with MACE, and (2) this association would attenuate differences in MACE by race or ethnicity, as well as by household income. Methods: We identified 212,744 individuals with a CR-qualifying event between 1/1/16 and 12/31/20 in Optum’s de-identified Clinformatics® Data Mart database. We evaluated associations between CR sessions attended (0 to 36) and MACE (cardiac arrest, heart failure, myocardial infarction, or stroke hospitalizations) using a proportional hazards model for recurrent events, and assessed the three-way interaction between CR participation, race or ethnicity, and household income. Results: We included 212,744 individuals (age 70.8±11.3 years; 37.8% female sex; 71.9% White race) of whom 26.0% attended ≥1 CR sessions. Overall, we observed a dose-response association between CR participation and MACE. After adjustment, those who did not attend CR were 2.9 times as likely to experience MACE as those who attended ≥36 sessions (95% CI: 2.71, 3.03, P &lt;0.0001), for whom there were no significant differences by race or ethnicity ( Figure ). Associations between CR participation and MACE were similar both across race or ethnicity and by household income ( P , interaction=0.28). Conclusion: Greater CR participation is associated with lower risk of MACE, regardless of (1) race or ethnicity and (2) household income. Because participation in CR remains low, particularly in socially disadvantaged populations, interventions to promote use of CR are critical to reduce disparities in cardiovascular outcomes.
Abstract P376: Home Blood Pressure Telemonitoring Linked With Community Health Workers to Improve Blood Pressure: The LINKED-BP Program
Authors: Yvonne Commodore-Mensah, Xiaoyue Liu, Oluwabunmi Ogungbe, Chidinma A Ibe, Sharon Moyo-Songonuga, Johnitta Amihere, Margaret Mensa, Tye Lane, Seth S Martin, Deidra Crews, Lisa A Cooper, Cheryl R Dennison Himmelfarb
Journal: Circulation (2023)

Background: Hypertension disparities persist in underserved populations in the United States. Presently, few implementation trials have focused on adults with elevated blood pressure (BP) or untreated stage 1 hypertension. To address this scientific gap, we have developed a pragmatic cluster-randomized controlled trial, the “LINKED-BP Program,” a patient-centered, multi-level intervention linking home blood pressure monitoring (HBPM) via a telemonitoring platform (the Sphygmo BP application) that integrates Bluetooth-enabled validated BP devices, support from community health workers, and BP measurement training at primary care practices to improve BP. The LINKED-BP Program is one of the five studies in the RESTORE (Add RE ssing S ocial Determinants TO p R event hyp E rtension) Network, an American Heart Association-funded initiative focused on the prevention of hypertension. The study aims to examine the effect of the LINKED-BP Program on BP reduction, as well as to evaluate the reach, adoption, sustainability, and cost-effectiveness of the intervention. Methods: We are recruiting 600 adults with elevated BP or untreated stage 1 hypertension from 20 primary care practices that provide care to underserved populations in Maryland and Pennsylvania. The practices are randomly assigned to the intervention or the enhanced usual care arm. Patients in the LINKED-BP Program receive training on HBPM with a validated home BP monitor, BP telemonitoring through the Sphygmo app, and community health worker visits for education and counseling on lifestyle modification over 12 months. Data are collected at baseline, 6, 12, and 24 months. The primary clinical outcome is a change from baseline in systolic BP at 6 and 12 months. Discussion: The LINKED-BP Program tests a sustainable, scalable approach to prevent hypertension and advance health equity. The study findings will inform implementation strategies that address social determinants of health and barriers to hypertension prevention in underserved populations.